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Long-Term Results of a Prospective Trial of Mantle Irradiation (RT) Alone for Early-Stage Hodgkin's Disease (HD)
Reviewer: Christopher Dolinsky, MD
University of Pennsylvania School of Medicine
Last Modified: October 18, 2005
Presenter: Andrea Ng
Presenter's Affiliation: Brigham and Women's Hospital, Boston, MA
Type of Session: Scientific
- The historical approach to the management of early stage Hodgkin's disease was radiation alone.
- Recently, the standard of care has become a combination of chemotherapy and radiation therapy in an effort to decrease long term treatment related morbidities.
- However, radiation therapy alone can cure a large proportion of patients with early stage Hodgkin's disease.
Materials and Methods
- Between 1988 and 2000, 87 patients with pathologic stage I-IIA or clinical stage IA Hodgkin's disease were enrolled on a prospective trial of radiation alone.
- Patients were excluded if they had large mediastinal adenopathy, B symtoms, subcarinal disease or hilar disease.
- The median dose delivered to the mantle field was 36 Gy (range 30-40 Gy).
- Patients were followed closely after therapy.
- Median follow-up was 109 months (range 23 to 192 months).
- 13 of 87 patients relapsed with a median time to relapse of 30 months.
- 10 patients relapsed out of the field, 1 relapsed in-field, and 2 relapsed both in and out of the field.
- The 10 year freedom from treatment failure rate was 84.7%.
- Neither stage, histology or the presence of mediastinal disease were statistically related to treatment failure.
- 12 of the 13 patients with relapse were able to be salvaged with ABVD chemotherapy +/- radiation and the other patient was salvaged with an autologous bone marrow transplant.
- 5 second malignancies were seen (4 breast cancers and 1 uterine cancer) and were responsible for 2 deaths.
- 2 patients developed myocardial infarction and 1 patient developed cardiomyopathy after ABVD chemotherapy.
- 10 year overall survival was 98.2%.
- Mantle radiation alone in well selected early stage Hodgkin's disease patients yields long term survival outcomes comparable to the current standard of combined modality therapy.
- The late complications of mantle field radiation appear to be modest, although additional follow-up is needed to determine the actual solid tumor risk.
- This data needs to be taken with caution given that it was collected in the era of staging lapartomies.
The authors presented an interesting and well designed prospective trial examining the outcomes for mantle field radiation alone in selected early stage Hodgkin's disease patients. With outstanding overall survival rates (98% at 10 years), this treatment option should be considered in patients who are not candidates for combined modality therapy, or have contraindications to chemotherapy. The major risk to mantle field radiation alone in this disease appears to be related to the likelihood of developing second malignancies following therapy. This is particularly concerning in women, because of the risk of developing a secondary breast cancer. If long term data for combined modality therapy ends up showing a similar risk for second malignancies and cardiac toxicity as radiation alone, then perhaps the treatment paradigm for this disease may change.